Timely identification of spinal injury is important to streamline treatment and optimize outcomes. Improved imaging techniques allow for unprecedented diagnosis of spine injures. Effective implementation of available imaging techniques remains a less than straightforward undertaking due to large number of variable factors that affect trauma patients. Missed spinal injuries may cause additional disability and even death. In this segment insights in preventing missed injuries through application of a risk-adjusted approach are discussed followed by a presentation of new approaches in classifying spine trauma. From the Series:Seventh Annual Harborview Spine Symposium: Improving Outcomes of Spinal Injury